'Cut drug use for dementia'

1 November 2010 Last updated at 06:20 ET

The use of anti-psychotic drugs for dementia patients must be cut by two-thirds by November 2011, the minister responsible has warned doctors.

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Care Services Minister Paul Burstow sets out limits for use of anti-psychotics in dementia sufferers.

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Care Services Minister Paul Burstow told Panorama that GPs must "take responsibility" and drastically reduce the amount of drugs being prescribed.

Evidence suggests the drugs - used to control aggressive behaviour - have dangerous side effects.

A leading GP said most doctors agree that their use needs to be curtailed.

Mr Burstow said the evidence for cutting their use is compelling: "It kills people. It cuts their lives short. It reduces the quality of their lives. It is now time for those responsible for prescribing to take responsibility and cut the prescribing, and make sure we improve the quality of life for people with dementia."

'Chemical cosh'

A study commissioned for the government reported in 2009 that anti-psychotics are being prescribed to 180,000 patients and their side effects, including increased risk of stroke, mean that the deaths of 1,800 people a year are attributable to their use.

Mr Burstow, the Liberal Democrat minister, campaigned in opposition on behalf of dementia patients and their families to reduce the reliance on the drugs both for patients being cared for at home and those in care facilities.

Continue reading the main story

"Start Quote

He was virtually comatose is the only way to explain it"

End Quote Glynne Thompson Wife of dementia sufferer

Most of the drugs were developed in the 1950s for the treatment of psychosis and are not licensed for long term use with dementia.

They are prescribed "off label" for dementia patients because of their strong sedative effects and doctors have turned to them to deal with the behavioural symptoms of dementia patients.

They are supposed to be used as a last resort and only prescribed for short periods and one at a time.

Professor Tim Kendall, who wrote the current guidelines on when and how anti-psychotics should be used, is critical of how much they are being relied upon.

"By far and away the most common use is to control people's behaviours. It's nothing more than a chemical cosh," he said.

The government currently spends more than �80m on anti-psychotic drugs for dementia patients a year - and spends �8.2bn overall in the treatment of dementia.

"I don't think we're spending that �8.2 billion at all well. If we were spending it well we wouldn't have this unacceptable level of prescribing anti-psychotics in the system," Mr Burstow said.

'Virtually comatose'

Professor Steve Field, chairman of the Royal College of General Practitioners, said reliance on the drugs is part of a wider problem in the system and most GPs agree that their use needs to be reduced.

"This isn't just about prescribing, this is about the whole system. It needs to change the system is a disgrace as it is at the moment and we all need to do better."

Glynne Thompson has been attempted to wean her husband Ken, who she cares for at home, off the anti-psychotics that he was prescribed in order to control his behaviour as his dementia worsened.

"He was virtually comatose is the only way to explain it - constantly dribbling, it was like being confronted with a baby that couldn't do anything for themselves," Mrs Thompson said of the side effects of the drugs.

Panorama: What Have the Drugs Done to Dad, BBC One, Monday, 1 November at 2030GMT and then available in the UK on the BBC iPlayer.

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Alcohol &#39;harms more than heroin&#39;

31 October 2010 Last updated at 20:29 ET

Alcohol is more harmful than heroin or crack, according to a study published in medical journal the Lancet.

The report is co-authored by Professor David Nutt, the former UK chief drugs adviser who was sacked by the government in October 2009.

It ranks 20 drugs on 16 measures of harm to users and to wider society.

Tobacco and cocaine are judged to be equally harmful, while ecstasy and LSD are among the least damaging.

Prof Nutt refused to leave the drugs debate when he was sacked from his official post by the former Labour Home Secretary, Alan Johnson.

He went on to form the Independent Scientific Committee on Drugs, a body which aims to investigate the drug issue without any political interference.

One of its other members is Dr Les King, another former government advisor who quit over Prof Nutt's treatment.

Classification system

Members of the group, joined by two other experts, scored each drug for harms including mental and physical damage, addiction, crime and costs to the economy and communities.

The modelling exercise concluded that heroin, crack and methylamphetamine were the most harmful drugs to individuals, but alcohol, heroin and crack cocaine were the most harmful to others.

Continue reading the main story

"Start Quote

If you take overall harm, then alcohol, heroin and crack are clearly more harmful than all others"

End Quote Prof David Nutt Former UK chief drugs adviser

When the scores for both types of harm were added together, alcohol emerged as the most harmful drug, followed by heroin and crack.

The findings run contrary to the government's long-established drug classification system, but the paper's authors argue that their system - based on the consensus of experts - provides an accurate assessment of harm for policy makers.

"Our findings lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm," the paper says.

"They also accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy."

In 2007, Prof Nutt and colleagues undertook a limited attempt to create a harm ranking system, sparking controversy over the criteria and the findings.

Legal high

The new more complex system ranked alcohol three times more harmful as cocaine or tobacco. Ecstasy was ranked as causing one-eighth the harm of alcohol.

It also contradicted the Home Office's decision to make so-called legal high mephedrone a Class B drug, saying that alcohol was five times more harmful. The rankings have been published to coincide with a conference on drugs policy, organised by Prof Nutt's committee.

Prof Nutt said: "What a new classification system might look like would depend on what set of harms to self or others, you are trying to reduce.

"But if you take overall harm, then alcohol, heroin and crack are clearly more harmful than all others."

The Lancet paper written by Prof Nutt, Dr King and Dr Lawrence Phillips, does not examine the harm caused to users by taking more than one drug at a time.

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Sleep loss &#39;worse for extroverts&#39;

31 October 2010 Last updated at 20:32 ET

Outgoing people appear to suffer worse from the effects of lack of sleep, US army researchers suggest.

They kept 48 volunteers awake for 36 hours, with some allowed to mix with others, the journal Sleep reports.

Those defined as introverts did better at staying awake and in reaction tests.

And those extroverts who were denied social contact also did well, suggesting it is "social stimulation" that tires out the parts of the extroverts' brains linked to alertness.

The study involved 48 people aged 18 to 39, who were divided into two roughly equal groups following personality type screening, which defined whether they were natural extroverts or introverts.

After a good night's sleep, they remained awake for a day and a half, with various tests each hour to measure the effects of lack of sleep.

Some of the test subjects - both introverts and extroverts - were allowed to take part in group discussions, and play board games and puzzles for 12 hours of the 36. The others were not allowed any such social interaction.

First of all, the test subjects who were "socially enriched" in this way were tested to see if there was any difference between the natural extroverts and introverts.

While there was little difference in one of the tests, in which volunteers had to push a button as soon as possible in response to a light, introverts fared better in a "maintenance of wakefulness test", which checks whether sleep-deprived people are able to stay awake over a set period of time.

The extroverts in that group did badly in the test, but the extroverts in the second group - those denied social contact - performed markedly better.

Perception

The researchers, from the Walter Reed Army Institute in Maryland, said the results suggested that personality type might not only have a bearing on ability to cope with military tasks which required being awake for long period, but also with shift work.

They reported: "Overall, the present results might also be interpreted more generally to suggest that waking experiences, along with their interaction with individual characteristics, influence vulnerability to subsequent sleep loss."

Continue reading the main story

"Start Quote

The extrovert is more likely to be influenced by a perception of what is going on in the group"

End Quote Professor Mark Blagrove, University of Swansea

One possibility, they said, was that intense social interactions might lead to fatigue in brain regions which also played a role in alertness.

Conversely, they said, it was possible that introverts might always have a relatively high level of activity in parts of the brain affected by social situations.

On a day-to-day basis, it is suggested this could mean that social contact leads to "over-stimulation", explaining why introverts would withdraw or shy away.

However, the constant activity might also make their brains better placed to fight the effects of sleep deprivation, they said.

One UK academic said that there might be a simpler explanation for the different impact of sleep deprivation.

Professor Mark Blagrove, a neuroscientist from the University of Swansea, has published similar research into effects of sleep deprivation on the mood of introverts and extroverts.

Again, he found extroverts more vulnerable to mood changes driven by lack of sleep.

He said: "We suggested that extrovert people might be more heavily influenced by the sleep-deprived appearance of people in the group around them.

"They found no differences in the objective test of alertness they used, but did find differences in the wakefulness test, which is a slightly less objective measure of how someone is feeling.

"This supports a slightly simpler argument - that the extrovert is more likely to be influenced by a perception of what is going on in the group."

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Miniature livers &#39;grown in lab&#39;

30 October 2010 Last updated at 14:30 ET

Scientists have managed to produce a small-scale version of a human liver in the laboratory using stem cells.

The success increases hope that new transplant livers could be manufactured, although experts say that this is still many years away.

The team from Wake Forest University Baptist Medical Center presented its findings at at conference in Boston.

UK experts said it was an "exciting development" but it is not yet certain a fully-functioning liver is possible.

The demand for transplant livers far exceeds the number of available organs, and in recent years, research has focused on ways to use cell technology to support failing organs in the body, or even one day replace them.

Their building block is the stem cell, a "master cell" which can, in certain conditions, can divide to produce different types of body tissue.

However, constructing a three-dimensional organ from stem cells is a difficult task.

'Technical hurdles'

The method used by the Wake Forest researchers, and other teams around the world, is to form new liver tissue on a scaffold made from from the structure of an existing liver.

In this case, a detergent was used to strip away the cells from the liver, leaving only the collagen framework which supported them, and a network of tiny blood vessels.

Continue reading the main story

"Start Quote

Whilst 'off the shelf' new livers are clearly still a long way off, this work gives a glimmer of hope that this is no longer just the stuff of science fiction"

End Quote Dr Mark Wright, Southampton University

The new stem cells - in this case immature liver cells - and endothelial cells, to produce a new lining for the blood vessels, were gradually introduced.

After a week in a "bioreactor", which nurtured the cells with a mixture of nutrients and oxygen, the scientists saw widespread cell growth within the structure, and even signs of some normal functions in the tiny organ.

Professor Shay Soker, who led the research, said: "We are excited about the possibilities this research represents, but must stress that we're at an early stage, and many technical hurdles must be overcome before it could benefit patients.

"Not only must we learn how to grow billions of liver cells at one time in order to engineer livers large enough for patients, we must determine whether these organs are safe to use."

UK researchers welcomed the findings, which are being presented to the American Association for the Study of Liver Diseases. Professor Mark Thursz, from Imperial College London, said the results were "encouraging".

"The report suggests that the authors have overcome one of the major hurdles in creating an artificial liver - to generate functioning human liver cells in a 'natural' liver structure.

"It is clear that the cells are growing well, but the next step is to show that they are functioning like normal human liver tissue."

Dr Mark Wright, from Southampton University added: "In an era of increasing liver disease and death with a chronic shortage of liver transplants this represents an exciting development in an important field of work.

"The researchers appear to have made the step of combining stem cell technology with bioengineering as a first step to producing artificial livers.

"Whilst 'off the shelf' new livers are clearly still a long way off, this work gives a glimmer of hope that this is no longer just the stuff of science fiction."

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Forces less stressed than police

29 October 2010 Last updated at 10:16 ET By Katia Moskvitch Science reporter, BBC News

UK forces in Iraq are less stressed than police officers or disaster workers, scientists suggest.

A UK team surveyed 611 military personnel and found a fifth showed signs of "mental distress", a lower rate than that seen in the other high-stress occupations.

The British Journal of Psychiatry study was carried out in 2009.

But the charity Combat Stress said it was difficult to compare stress levels in such different occupations.

It is the first major study of the UK armed forces' mental health while on deployment in Iraq.

Neil Greenberg from King's College London, a co-author of the study, said that until now, most research on the psychological well-being of the UK armed forces in that country had been conducted either before or after their deployment.

But little was known about soldiers' mental health during actual service.

The team, led by Kathleen Mulligan, conducted a survey among 611 UK military personnel of different rank and gender serving in the country in 2009. This is about 15% of the total number of the UK armed forces in Iraq that year.

Overall, they found that there was "little overall effect of deployment on mental health", said Dr Greenberg.

Risk factors

The study states 92.6% rated their health as good, very good or excellent, and men as opposed to women were more likely to report good health.

Continue reading the main story

"Start Quote

Raising awareness among staff of the link between personnel reporting sick and having poorer mental health may help identify those in most need of psychological help"

End Quote Neil Greenberg King's College London

Other factors that appeared to help this self-rated well-being included being an officer, having a cohesive unit and supportive leadership.

Age seemed to matter as well: those who were younger reported more levels of stress and poorer health.

Finally, the scientists found that it was important for the armed forces to receive pre-deployment stress brief and to take periods of rest and recuperation.

"Although there is a policy that requires personnel to be given a pre-deployment brief, our study suggested this policy needs to be more rigorously enforced," said Dr Greenberg.

Even though 20% of those surveyed showed signs of mental distress, only 3% were found to possibly have post-traumatic stress disorder (PTSD).

This is lower than among workers in other high-stress occupation, "such as police officers, doctors in emergency departments and disaster workers", the report said.

But a spokesman from a UK charity Combat Stress told BBC News that comparing soldiers in the field to people in other professions was like comparing "apples and peaches".

"The whole military psyche is 'get on, crack on, put up', and there are people rightly or wrongly not willing to express their problems," he said.

"And I think this is an antithesis of the attitude of employees in the public services.

"I think there are cultural things in play here that are perhaps not apparent in the groups that they compared."

Dr Greenberg underlined that it was vital to ensure medical support in military units that covered mental health disorders.

"Improving training, as well as raising awareness among staff of the link between personnel reporting sick and having poorer mental health may help identify those in most need of psychological help," he said.

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Baby P doctor can challenge GMC

29 October 2010 Last updated at 07:10 ET

A doctor accused of failing to spot signs that Baby P was being abused has won the right to legally challenge a General Medical Council disciplinary hearing against her.

Dr Sabah Al-Zayyat is seeking to overturn a GMC ruling that refused to grant her "voluntary erasure" from the medical register on health grounds.

The judge ordered that her challenge be heard in the High Court in November.

The GMC panel must stop its hearing until the challenge is heard, he said.

Dr Al-Zayyat's counsel argued that the panel's decision was "perverse" in the light of medical evidence that the doctor is not well enough to participate in the hearing.

The doctor, who is facing disciplinary action over her conduct, had her application to be removed from the medical register rejected earlier this week.

The GMC ruled that the "serious" allegations against her should be heard in public.

It could ban her from working in the UK.

GMC panel chairman Ralph Bergmann said: "The application for voluntary erasure would avoid a public, and necessary, examination of the facts of this case."

Mr Bergmann added that the doctor's interests were outweighed by the need to maintain public confidence in the medical profession and in the GMC.

Serious injuries

Dr Al-Zayyat saw 17-month-old Peter Connelly at St Ann's Hospital in Haringey days before his death in 2007.

She is accused of failing to carry out an "adequate examination", investigate his injuries or admit him to hospital.

A post-mortem examination found he had probably suffered serious injuries, including a broken back and fractured ribs, before he was examined by Dr Al-Zayyat.

Dr Al-Zayyat is also accused of knowing Peter was on the child protection register.

She had her contract with Great Ormond Street hospital terminated after details of Peter's case came to light.

Dr Al-Zayyat, who did not attend this latest hearing, was originally due to face GMC disciplinary action in February.

The earlier session was adjourned after the panel heard she was "suicidal", unfit to defend herself and had left the country.

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